Aims

Giant cell tumour of bone (GCTB) treatment changed since the introduction of denosumab from purely surgical towards a multidisciplinary approach, with recent concerns of higher recurrence rates after denosumab. We evaluated oncological, surgical, and functional outcomes for distal radius GCTB, with a critically appraised systematic literature review.

Introduction: The aim of this study was to determine the impact of deprivation on access to and outcome from total hip replacement in a district general setting.

Methods: A prospective audit was undertaken in an elective orthopaedic centre serving an entire health region. Hip function was collected using the Harris Hip Score (HHS) Patients were followed up for a mean 71 months and the presence of complications noted.

Patients were allocated a deprivation category by retrospective application of the Scottish Index of Multiple Deprivation (SIMD) quintiles.

Results: A total of 2270 hip replacements were carried out in 2177 patients. There were 93 bilateral simultaneous procedures. The overall incidence of THR was 79.5/100,000 per year. This rate was significantly higher in more deprived areas. 37.4% of THRs occurred in males but there was no significant change with deprivation. Deprivation was not linked with age, length of stay or BMI. There was no association with the prevalence of diabetes, cancer, ischaemic heart disease or hypertension in this group. The incidence of smoking increased with deprivation, with a prevalence of 21.5% in the most deprived group compared to 7.7% in the least (p=0.0001). There was no observed difference in mortality, infection, dislocation, thrombosis or transfusion requirement. Preoperative and postoperative function was significantly different between groups with HHS being lower in the most deprived group compared to the least (p=0.01, p=0.005). There were ‘pockets’ of low and high incidence of THR. These correlate with the age of the population (r=0.69, p< 0.001).

Conclusion: We could identify no inequality in access to total hip replacement in our centre and health board region. The incidence of smoking increased with increasing deprivation. Areas with a greater proportion of the population over 60 had an increased incidence of THR. Pre-operative function and outcomes were found to be lower in more deprived groups.

Thermonecrosis either results in bone loss which may weaken the purchase of surgically-inserted screws leading to loosening or the dead bone may remain in situ and become infected resulting in a ring sequestrum. The aim of this project was to measure the heat generated during drilling of bone. By using a novel realtime thermal camera the thermal events could be visualised topographically.

An experimental setup comprising a force table, an infrared camera, a power drill and a new surgical 2.5mm drill bit was constructed. This enabled measurements of the force applied and temperature changes in sheep cortical bone during a drilling operation. The temperature was observed throughout the drilling period and for further 15s after the drill bit was withdrawn. Images were grabbed using a LAND FTI Mv thermal camera which was driven by LIPS Mini software. Calibration was made in the range 20-200 degrees C, the upper value being provided by a high wattage resistor. Data was processed using routines written in MATLAB.

It was found that 12s were required to drill through a single cortex. Within one second of drilling, the maximum recorded temperature in the vicinity of the drill increased from the baseline of 20 to 170 degrees C. It remained above this temperature for 25s. Immediately after the drill bit was withdrawn, a region of approximately 15mm of diameter of cortical surface had a sustained temperature above 50 degrees C. After 15s of cooling, this diameter had only reduced to 10mm. By modelling the cooling curve, the maximum temperature at the drill tip was extrapolated to be between 500-600 degrees C.

Thermography has proven to be useful in the study of the thermal characteristics of bone during drilling. The process of drilling generates significant increase in temperature in the vicinity of the drill. This temperature elevation has been found to be sustained for a significant period of time.

Introduction: SF-36 is a validated 36-item questionnaire that measures eight dimensions of quality of life(QoL): physical functioning(PF), role physical(RP), role emotional(RE), social functioning(SF), mental health(MH), energy/vitality(EV), bodily pain(Pain) and general health perception(GHP). The primary aim of the study was to evaluate QoL outcomes after total hip replacement(THR) using SF-36.

Methods: From 5/1/1998 until 16/8/2005, we prospectively collected data on 569 patients who had THR in Fife. 30 of them had bilateral THR. Each patient was assessed pre-operatively and was reviewed at 6 months, 18 months, 3 years and 5 years post-operatively. A SF-36 was filled in at each appointment.

Results: During the period, 6 patients died, 4 had revision, 19 were lost to follow-up and 46 did not attend their 5-year review. Subsequently, 494 patients had a 5-year review but 46 of them did not fill in the questionnaire. Analysis was performed on the remaining 448 patients (male=179, female=269).

Mean scores of PF, RP, RE, SF, EV and Pain improved significantly following THR. The improvement remained significant throughout the follow-up (p< 0.0005). MH was the only dimension which did not change significantly after THR. There was a significant decline in GHP (p< 0.0005).

Females reported lower scores in all dimensions apart from GHP. They were also significantly older than the males (66.66±9.41 vs. 64.69±10.27 years; p< 0.037).

Patients who had unilateral or bilateral THR reported similar scores preoperatively and in the initial follow-up. Significant differences were only noted at 3 and 5 years with the bilateral group reported a higher score.

Discussion: THR improved QoL and the benefit was still evident at 5 years post-operatively. However the perception of general health continued to deteriorate, probably due to the effects of aging. More advanced age of females might partly contribute to their lower scores.